A Novel Intervention Promoting Eating Disorder Treatment Among College Students

Eating disorders (EDs) have the highest rate of mortality of any mental illness. ED age of
onset coincides with the undergraduate years (ages 18-25). As such, colleges provide access
to a large, epidemiologically vulnerable population and present a unique opportunity for
intervention. On college campuses, 14% of female and 4% of male students screen positive for
clinically significant EDs. An estimated 80% of these students do not receive treatment.
Left untreated EDs typically become more severe and refractory to treatment. Help-seeking
interventions typically focus on minimizing stigma, improving knowledge, and addressing
other barriers emphasized by classic theories of health behavior. On the whole, these
interventions have failed to increase treatment utilization for the vast majority of
students with ED symptoms. Innovative approaches are urgently needed to narrow the ED
treatment gap on college campuses.

The proposed study builds on the most comprehensive research to date on mental health
service utilization in college populations, which the Principal Investigator of this study
(PI) has developed with her faculty advisor. Findings reveal new insight into the ED
treatment gap: students with untreated EDs report not seeking help for reasons such as lack
of time, lack of perceived need, ambivalence about the severity of need, belief that the
problem will resolve itself without treatment, and a desire to deal with issues "on my own."
These reasons imply a lack of urgency but not necessarily a strong resistance to receiving
treatment. In similar health contexts (e.g., for diet/exercise, use of preventative care),
behavioral economic interventions have produced positive results by addressing several
cognitive biases, including the default bias (individuals 'go with the flow' of preset
options) and the sign effect (losses (negative outcomes) are substantially more
psychologically costly than gains (positive outcomes)). The present intervention study
addresses these biases in an effort to increase service use among undergraduate students
with untreated ED symptoms (as identified in an online screen).

In a 12-week study, the study team is using a factorial design to test the effects of three
intervention components: peer norming, default option, and sign effect. The intervention
components are delivered via email messaging. To address the default bias, email messages
reframe treatment use as an opt-out (as opposed to opt-in) behavior, thus nudging students
to seek help. Students are able to check a box to opt out of receiving treatment linkage.
Those who do not opt-out receive, without any purposeful action, continued assistance
connecting to treatment. For the sign effect, messages emphasize the negative consequences
of untreated EDs to engender urgency. Students in conditions with peer norming see how their
levels of eating disorder symptoms (results from widely-used, validated measures included in
the baseline survey) compare with average symptom levels among other undergraduates (with
data taken from national surveys previously conducted by the study team). Follow-up data is
being collected at weeks 6 and 12. Intervention components are operationalized in electronic
messages delivered over 12-weeks (anticipated: January-May 2015).

Inclusion Criteria:

- Undergraduate at participating university

- Untreated symptoms of an eating disorder (as identified in an online screen)

Exclusion Criteria:

- Less than 18 years of age

- Studying abroad during study period